TRICARE Overseas Program Provider Manual

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TRICARE overseas Program Provider Manual Access to Care International SOS is committed to ensuring that TOP beneficiaries have access to quality care with suitable wait times and other standards of service delivery. Below is an overview of these standards and guidelines, as established by TRICARE policy. Element Wait Time for an Appointment office Waiting Times ToP Access to Care Standards Definition When a TRICARE beneficiary contacts you to make an appointment, you are expected to follow the guidelines below for seeing the patient: — Well-patient Visit or Specialty Care Referral: 4 weeks — Routine Visit: 1 week — Urgent Care: 24 hours When a TRICARE beneficiary comes in for their appointment, the office waiting time to see their clinician can be no more than 30 minutes – unless the clinician’s schedule is disrupted because of a medical emergency. Service Standard Well-patient: 4 weeks Routine: 1 week Urgent: 24 hours No more than 30 minutes Provider Credentialing Process With 25 years of experience in international health care and medical assistance services, and operations in 70+ countries, International SOS understands that health care delivery differs significantly from country to country. Factors such as local country legislation and regulations are considered, as well as existing health care infrastructure and any unique challenges that may impact the delivery of care in a specific region. International SOS takes these differences into account, when reviewing Provider capabilities and determining eligibility to participate in TOP. Country-specific credentialing guidelines are used and we work with host nation licensing agencies, to maintain accurate and up-to-date information about local standards. Provider performance is monitored on an ongoing basis so that potential problems can be addressed before they impact beneficiary satisfaction and quality of care. Provider satisfaction surveys are also used to monitor your overall satisfaction with International SOS, including how accessible or helpful our call center and TOP Provider Support Services staff is in assisting with claims processing, Provider education, and other topics. The following credentialing items are required to become an International SOS Network Provider: Availability of Emergency Services Providers of emergency care services are expected to be available 24 hours a day, 7 days a week. Emergency care Providers are selected based on their abililty to meet this requirment. If your availability changes, you must notify us immediately. 24 hours a day / 7 days a week Note: If you have any questions or concerns about your ability to meet these standards and guidelines, please contact International SOS. 26
TRICARE overseas Program Provider Manual Criteria Signed Provider Agreement Meet the Standards for Authorization Standards An International SOS Provider Agreement (Mutual Cooperation Protocol) must be signed, in order to become a Network Provider. All health care services for TOP Prime and TOP Prime Remote beneficiaries are provided on an authorized basis. You will be expected to accept International SOS’ authorization for services, and agree to submit claims and invoices for payment to International SOS, through our subcontractor Wisconsin Physicians Service (WPS). You agree not to balance bill a TOP Prime or TOP Prime Remote beneficiary for uncovered services. Valid Malpractice Insurance (If Applicable) Licensure/Registration Evidence of Professional Qualifications and Experience You must have professional liability insurance, if this is required by the laws of your respective host nation. If you are a country, state, province, etc., entity Provider, and you are self-insured, then you are not required to have malpractice insurance. You must meet the requirements for licensure/registration as specified by your local governmental authority or licensing board. This includes having a valid license or registration in the host nation where you practice. You must be a graduate of an accredited program in health care sciences. This includes completing a certificate (residency) program, leading to certification in general medicine, family practice, gynecology, pediatrics, dentistry or other disciplines/specialties recognized by the applicable certifying agency in your country. SECTIoN 3 International SoS Network Providers & Provider Credentialing English Language Proficiency You must be able to proficiently communicate in English (both verbally and in writing), or to provide English translation and interpretation services at the time of service. Beneficiary Access to ToP Network Providers All Host Nation Providers with a signed Mutual Cooperation Protocol Agreement and approved credentials on file with International SOS will be published on www.tricareoverseas.com and displayed for beneficiaries. The published list of Network Providers is matched with International SOS’ internal database, so it is important that you keep all of your information up-to-date. TRICARE beneficiaries using the www.tricare-overseas.com website have the comfort of knowing that listed Providers are “quality assured” and recommended for care locally. Detailed information about referrals and authorizations is also included on this website, making Provider selection easier and more convenient for beneficiaries. Note: If you would not like your Provider information published, please contact your TOP Regional Call Center and select option #5 to speak with a member of the TOP Provider Support Services staff. 27
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